There has been reported that the association between nodal spread and tumor size was disrupted in triple-negative breast cancer (TNBC) and it showed characteristically early relapse. The TNM ...(tumor–node–metastasis) staging system might not be equally effective as a prognostic indicator for all subtypes. The aim of our study was to evaluate the usefulness of the staging according to subtypes.
We conducted a retrospective analysis of invasive breast cancer patients who received curative surgery at Samsung Medical Center from 2000 to 2004. Relapse-free survivals (RFS) by stage were analyzed.
Thousand eight hundred and seventy-nine patients who were available clinicopathologic data were included. These patients were divided into three subtypes: hormone receptor (HR)+, human epidermal growth factor receptor 2+, and triple negative groups. As the stage became more advanced, the slope of each stage of the RFS curves of patients with HR+ and HER2+ steadily increased. In contrast, RFS curves intermingled and showed overlap from stage 1 to 3A in TNBC patients. There was only wide separation of RFS curves between stage 1-3A and 3B-3C in TNBC.
The current TNM staging system might not be enough for encompassing the tumor biology and for predicting outcomes to make therapeutic decisions for all BCs, especially for TNBC patients.
Abstract
In this study, we demonstrate argon-seeded discharges that exhibited a detached divertor during the full suppression and mitigation of edge-localized modes (ELMs) by an International ...Thermonuclear Experimental Reactor-like, three-row resonant magnetic perturbation (RMP) configuration in KSTAR. During the ELM suppression phase, the peak heat flux on the divertor target was successfully reduced from 1.6 MW m
−2
–0.5 MW m
−2
via argon seeding. Further, the ion saturation current densities corresponding to the particle fluxes on both targets were reduced by more than 50%. During the RMP grassy-ELM regime, a further reduction to 0.1 MW m
−2
in the divertor heat load was successfully achieved. A highly localized radiation zone near the
X
-point was also observed during divertor detachment. The calculated degree of detachment based on the two-point model increased to levels of approximately 3 and 2.3 for the outer target and inner target cases, respectively. These results provide valuable information regarding the effect of mid-
Z
impurities on RMP-detachment-compatible discharges.
Atorvastatin is a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor that is mainly metabolized by cytochrome P450 (CYP) 3A4. A recent study showed that the lipid-lowering effect of ...statins is affected by the CYP3A5 polymorphism. Therefore, it was investigated whether CYP3A5 contributes to the metabolism of atorvastatin. Two metabolites of atorvastatin, para- and ortho-hydroxyatorvastatin, were produced by human liver microsomes and human recombinant CYP3A enzymes, and the enzyme kinetic pattern exhibited substrate inhibition. The intrinsic clearance (CLint) rates of para- and ortho-hydroxyatorvastatin by CYP3A4 were 2.4- and 5.0-fold of the respective CLint rates of CYP3A5, indicating that CYP3A4 is the major P450 isoform responsible for atorvastatin metabolism. These results suggest that atorvastatin is preferentially metabolized by CYP3A4 rather than by CYP3A5, and thus the genetic CYP3A5 polymorphism might not be an important factor in the inter-individual variation of atorvastatin disposition and pharmacodynamics in human.
An open-label, randomized trial was conducted to examine the effects of risedronate versus menopausal hormone therapy (MHT) in postmenopausal women with recent hip fracture.
Among 1165 eligible ...women, 281 were recruited and randomly assigned to receive oral risedronate (35 mg/week) or percutaneous estradiol gel (1.5 mg/day) plus oral micronized progesterone (100 mg/day) for 4 years. The primary end point was recurrent fracture and the secondary end points were mortality and bone mineral density (BMD).
Kaplan-Meier analyses showed no significant differences in fracture recurrence and mortality between the two groups. The incidence of any new fracture per 100 person-years (PY) was 8.63 in the risedronate group and 12.86 in the MHT group (p = 0.180); that of clinical fracture was 4.75 and 6.99, respectively (p = 0.265); and that of asymptomatic vertebral fracture was 4.87 and 5.58, respectively (p = 0.764). The respective incidence of death per 100 PY was 3.58 and 4.40 (p = 0.503). BMD increased comparably at the lumbar spine in both groups. BMD at the total hip did not change in the risedronate group, but increased significantly by 2.8% in the MHT group.
MHT might not differ from risedronate in the prevention of secondary fractures and death among postmenopausal women with recent hip fracture.
Abstract
Background
Elder abuse is recognized as a serious public health concern and top priority aging issues. World Health Organization reported that around 1 out of 6 old people in the world ...experienced some form of abuse. This study was carried out to find out the prevalence of different forms of abuse among elderly Nepalese people.
Methods
The cross-sectional, quantitative analytical study was carried out among 373 elders of the Syangja district of Nepal. The study population was selected through simple, proportionate, and systematic sampling methods. Data was collected through face-to-face interviews using a structured questionnaire.
Results
The majority of participants were female (54.5%). The prevalence of elderly abuse was found to be 54.5%. The most common form of abuse among the elderly population was neglect (23.1%), psychological abuse (20.6%), physical abuse (6.5%), financial abuse (2.4%), and sexual abuse (1.9%). Elderly females were significantly more likely to experience physical and psychological abuse.
Conclusion
More than half of the elderly experienced at least one form of abuse. Neglect was found to be the most common form of abuse. The abuse was prevalent among elderly who were ill and with the habit of tobacco and alcohol consumption.
Background and purpose
The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion‐weighted magnetic ...resonance imaging (DWI‐MRI) and whether ischaemic core size affects this rate remain to be investigated.
Methods
This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI‐MRI that was categorized into three groups: small Diffusion‐Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset‐to‐groin puncture time (OTP) and DWI‐ASPECTS categories regarding functional outcomes was investigated.
Results
Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI‐ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60‐min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15).
Conclusions
Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI‐ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.
In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ...ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear.
We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm
or less or measuring 3 to 4 mm
with a plaque burden of more than 70%. The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization. We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points).
The frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P = 0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups.
In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number, NCT02673424.).
Aim To determine the diagnostic performance of colour mapping and strain ratio for characterizing malignant thyroid nodules on ultrasonographic (US) elastography. Materials and methods The study was ...approved by the institutional review board and written informed consent was obtained. One hundred and thirty-one patients with 142 thyroid nodules >0.5 cm were prospectively enrolled between July 2010 and January 2011. Seven radiologists performed US elastography (iU22 Vision 2010; Philips, Seattle, WA, USA) using colour mapping and strain ratio for thyroid nodules blinded to the cytopathological results. Diagnostic performances of colour mapping alone, strain ratio alone, colour mapping and strain ratio, and colour mapping or strain ratio were compared using receiver operating characteristic (ROC) curve analysis. Results Of the 142 nodules, 69 (48.6%) were benign and 73 (51.4%) were malignant. Colour mapping of elastography showed a more frequent blue colour in malignant nodules than in benign nodules (65.8% versus 24.6%, p < 0.0001). A higher ratio than 1.21 as the best cut-off value was found in 65.8% of malignant nodules and 46.4% of benign nodules ( p = 0.030). Area under the ROC curve (AUC) of colour mapping alone was significantly greater than that of colour mapping or strain ratio (AUC = 0.706 versus AUC = 0.63, p = 0.0195) and similar to that of colour mapping and strain ratio (AUC = 0.673, p = 0.1364). Conclusion US elastography is helpful to predict malignant thyroid nodules. However, adding strain ratio to colour mapping does not improve performance compared to colour mapping alone.
Autism spectrum disorders (ASD) are neurodevelopmental disorders, and their incidence is increasing worldwide. Increased exposure to environmental metal lead (Pb) has been proposed as a risk factor ...associated with ASD. In the present study, BTBR T+ tf/J (BTBR) mice with ASD-like behavioral characteristics and control FVB mice were exposed gestationally and/or neonatally to Pb, and compared with highly social FVB mice to investigate neuroimmunological abnormalities. IgG1 and IgG2a levels in fetal brains from BTBR dams exposed to Pb (BTBR-Pb) were significantly higher than those of BTBR-controls (BTBR-C). However, this change did not occur in FVB mice exposed to Pb. The IgG1:IgG2a ratio was higher in both fetal and postnatal brains of BTBR mice compared to FVB animals regardless of Pb exposure. The IL-4:IFN-γ ratio was elevated in BTBR-Pb relative to BTBR-C mice, but this ratio was not markedly affected following Pb exposure in FVB animals. These findings suggest the potential for a Pb-driven predominant T
H
2-like reactivity profile in brain microenvironment present in BTBR mice. Brain-derived neurotrophic factor was decreased in fetal and postnatal BTBR-Pb brains relative to BTBR-C brains but not in FVB-Pb relative to FVB-C mice. Taken together, data demonstrate that Pb exposure might contribute to developmental brain abnormalities associated with ASD, particularly in individuals with genetic susceptibility to ASD.
Aim To compare automated volumetric breast density (VBD) measurement with visual assessment according to Breast Imaging Reporting and Data System (BI-RADS), and to determine the factors influencing ...the agreement between them. Materials and methods One hundred and ninety-three consecutive screening mammograms reported as negative were included in the study. Three radiologists assigned qualitative BI-RADS density categories to the mammograms. An automated volumetric breast-density method was used to measure VBD (% breast density) and density grade (VDG). Each case was classified into an agreement or disagreement group according to the comparison between visual assessment and VDG. The correlation between visual assessment and VDG was obtained. Various physical factors were compared between the two groups. Results Agreement between visual assessment by the radiologists and VDG was good (ICC value = 0.757). VBD showed a highly significant positive correlation with visual assessment (Spearman's ρ = 0.754, p < 0.001). VBD and the x-ray tube target was significantly different between the agreement group and the disagreement groups ( p = 0.02 and 0.04, respectively). Conclusion Automated VBD is a reliable objective method to measure breast density. The agreement between VDG and visual assessment by radiologist might be influenced by physical factors.
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